June 2013

Senior editor David Thompson looked into the looming shortage of doctors in Hawaii, particularly on the Neighbor Islands.

I was intrigued by David Thompson’s article regarding our physician shortage but my own experience in trying to recruit physicians to Maui is at odds with his. I have found that doctors decide not to come because reimbursement is too low, the cost of living is too high and the schools are lousy. They can buy a 5,000-square-foot house in Dubuque and a condo on the beach here where they spend more than a month a year and still be way ahead financially.

—Jon Betwee, M.D. • Wailuku, Hawaii

Your recent article about the physician shortage in Hawai‘i, in general, and the Neighbor Islands, in particular, fails to mention a few issues:

Doing business in a business-unfriendly state with onerous regulations dissuades young graduates, with no business experience, from starting a practice here.

Medicare reimbursements (which are not uniform throughout the country) are especially low in Hawaii. Our local insurance companies are more than pleased to peg their reimbursement rates to Medicare’s low rates. Our legislators could, if they had the will to do so, lobby for better reimbursements in Hawaii. Medicare reimbursements in Alaska are more than two times that of Hawaii. That is largely a result of intense lobbying and influence exerted by Alaska’s U.S. congresspersons and senators, notably Ted Stevens. Of course, the inhospitable weather in Alaska could have been a strong argument in favor of Alaska’s significantly higher reimbursement rates.

As we all know, Hawaii’s poor public educational system leaves much to be desired. This is especially a big factor for physicians with young children, who prefer to move back to the Mainland in order to provide their children with better educational choices.
The costs of buying a home on Maui, Kauai, Oahu and Kona (although not Hilo) are simply unaffordable for most young physicians with college loans.

Last, but not least, young spouses of young physicians seem to prefer Tinsel Town (Honolulu) to the natural beauty and the pace of life of the Neighbor Islands.

May 2013

20 years after the lawsuit that prompted the Felix Consent Decree, associate editor Tiffany Hill looks into how court-ordered reform has shaped special education in Hawaii, and what special education looks like in the state’s public schools today.

The DOE will never be in compliance with the Felix Decree. The state has no accountability for themselves and their paperwork; what makes you think they will think of the needs of the children? I have met only a handful of teachers who have bent over backwards and stayed after hours and spent their own money for the kids because their department heads turned their requests down for funding.